Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

Battaglia, Yuri; Zerbinati, Luigi; Piazza, Giulia; Martino, Elena; Provenzano, Michele; Esposito, Pasquale; Massarenti, Sara; Andreucci, Michele; Storari, Alda; Grassi, Luigi

doi:10.3390/jcm9040995

Cited by 9 publications

(15 citation statements)

References 53 publications

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“…Similarly, a Global Distress score (ESAS-TOTAL) was created by summing up all the scores on the single ESAS symptoms. The ESAS has been largely used in renal, hemodialysis patients and kidney transplant recipient, showing good psychometric properties [41][42][43]. The Italian versions of the ESAS and the DT, which have been shown to have good levels of validity [44][45][46][47], were used in this study.…”

Section: Methodsmentioning

confidence: 99%

Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data

et al. 2020

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Although the donation rate for deceased and living kidneys has been increasing, the donor organ availability meets only the 30% of kidney needs in Italy. Consequently, hemodialysis patients stay for a long time, an average of 3.2 years, on a waiting list for a kidney transplant with consequent relevant psychological distress or even full-fledged psychiatric disorders, as diagnosed with traditional psychiatric nosological systems. Recent studies report, however, a higher prevalence of other psychosocial syndromes, as diagnosed by using the Diagnostic Criteria for Psychosomatic Research (DCPR) in medically ill and kidney transplant patients. Nevertheless, no data regarding DCPR prevalence are available in patients waitlisted for a renal transplant (WKTs). Thus, the primary aim of this study was to identify sub-threshold or undetected syndromes by using the DCPR and, secondly, to analyze its relationship with physical and psychological symptoms and daily-life problems in WKTs. A total of 30 consecutive WKTs were assessed using the DCPR Interview and the MINI International Neuropsychiatric Interview 6.0. The Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist were used to assess physical and psychological distress symptoms and daily-life problems. A total of 60% of patients met the criteria for at least one DCPR diagnosis; of them, 20% received one DCPR diagnosis (DCPR = 1), and 40% more than one (DCPR > 1), especially the irritability cluster (46.7%), Abnormal Illness Behavior (AIB) cluster (23.3%) and somatization cluster (23.3%). Fifteen patients met the criteria for an ICD diagnosis. Among patients without an ICD-10 diagnosis, 77.8% had at least one DCPR syndrome (p < 0.05). Higher scores on ESAS symptoms (i.e., tiredness, nausea, depression, anxiety, feeling of a lack of well-being and distress), ESAS-Physical, ESAS-Psychological, and ESAS-Total were found among DCPR cases than DCPR non-cases. In conclusion, a high prevalence of DCPR diagnoses was found in WKTs, including those who resulted to be ICD-10 non-cases. The joint use of DCPR and other screening tools (e.g., ESAS) should be evaluated in future research as part of a correct psychosocial assessment of WKTs.

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Section: Methodsmentioning

confidence: 99%

Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data

et al. 2020

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“…Analogously, a physical distress sub-score (ESAS-PHYS) and a psychological distress sub-score (ESAS-EMOTIONAL) were computed as a sum of scores for the six physical symptoms and for the four psychological symptoms, respectively. The Italian version shows an acceptable level of validity and good psychometric properties in KTRs [ 38 , 39 ].…”

Section: Methodsmentioning

confidence: 99%

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

Battaglia

Zerbinati

Murri

et al. 2021

JCM

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Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT.

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“…Each patient was individually administered the Mini-International Neuropsychiatric Interview (MINI6.0) [32] and the DCPR interview [33], which both took about two hours. Before the diagnostic interviews, the patients filled in four self-report instruments: DS-IT [27], Post-Traumatic Growth Inventory (PTGI) [34,35], Edmonton Symptom Assessment System (ESAS-Revised) [8,[36][37][38], and Canadian Problem Checklist (CPC) [39,40] (Table 1). In agreement with other screening programs [39], we administered together the ESAS and the Canadian Problem Checklist (CPC) within the COMPASS tool (Comprehensive Problem and Symptom Screening) [40].…”

Section: Methodsmentioning

confidence: 99%

“…Post-Traumatic Growth Inventory (PTGI) [34,35] It evaluates the positive changes experienced in the aftermath of a traumatic event. [8,[36][37][38] It examines the severity of physical (i.e., pain, tiredness, nausea, drowsiness, lack of appetite, shortness of breath) and psychological symptoms (i.e., depression, anxiety, feeling of not well-being) on a 0 (no symptom) to 10 (the worst symptom) scale. An optional 10th psychological symptom was also added in this study, specifically the emotional distress item which corresponds to the Distress Thermometer, a worldwide validated tool to measure distress also on a 0-10 Visual Analog Scale.…”

Section: Self-report Instrumentsmentioning

confidence: 99%

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The Use of Demoralization Scale in Italian Kidney Transplant Recipients

Battaglia

Zerbinati

Piazza

et al. 2020

JCM

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Demoralization is a commonly observed syndrome in medically ill patients. The risk of demoralization may increase in patients after a kidney transplant (KTRs) because of the stressful nature of renal transplantation, psychosocial challenges, and adjustment needs. No study is available on demoralization amongst KTRs. The purpose of our study was to evaluate the validity of the Italian version of the Demoralization Scale (DS-IT) and the prevalence of demoralization in KTRs. Also, we aimed at exploring the association of the DS-IT with International Classification of Diseases (ICD) psychiatric diagnoses, post-traumatic growth (PTG), psychological and physical symptoms, and daily-life problems. A total of 134 KTRs were administered the MINI International Neuropsychiatric Interview 6.0. and the Diagnostic Criteria for Psychosomatic Research–Demoralization (DCPR/D) Interview. The DS-IT, the Edmonton Symptom Assessment System (ESAS), the Canadian Problem Checklist (CPC), were used to measure demoralization, physical and psychological symptoms, and daily-life problems; also, positive psychological experience of kidney transplantation was assessed with the PTG Inventory. Routine biochemistry and sociodemographic data were collected. Exploratory factor analysis demonstrated a four-dimensional factor structure of the DS-IT, explaining 55% of the variance (loss of meaning and purpose, disheartenment, dysphoria, and sense of failure). DS-IT Cronbach alpha coefficients indicated good or acceptable level of internal consistency. The area under the Receiving Operating Characteristics (ROC) curve for DS-IT (against the DCPR/D interview as a gold standard) was 0.92. The DS-IT optimal cut-off points were ≥20 (sensitivity 0.87, specificity 0.82). By examining the level of demoralization, 14.2%, 46.3%, 24.6%, and 14.6% of our sample were classified as having no, low, moderate, and high demoralization, respectively, with differences according to the ICD psychiatric diagnoses (p < 0.001). DS-IT Total and subscales scores were positively correlated with scores of ESAS symptoms and CPC score. A correlation between DS-IT loss of meaning and purpose subscale and PTGI appreciation of life subscale (p < 0.05) was found. This study shows, for the first time, a satisfactory level of reliability of the DS-IT and a high prevalence of severe demoralization in KTRs.

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Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

Cited by 9 publications

References 53 publications

Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data

Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

The Use of Demoralization Scale in Italian Kidney Transplant Recipients

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